1. Section Editor(s): Thompson, Elizabeth M. MSN, RN, CNOR

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On March 1, the government implemented a sequester, which is driving healthcare organizations to take stock and react with extensive measures.

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Sequestration is a set of government budget cuts intended to reduce the federal deficit.1 The budget cuts affect several government programs, including education, Head Start, and job search assistance.2 In addition, the sequester is expected to affect over 373,000 mentally ill adults and children, thousands of homeless people, and people with drug and alcohol problems.3 The effects to healthcare will be no less aggressive. The American Nurses Association, American Medical Association, and the American Heart Association generated a report that estimates a loss of 496,000 positions in the healthcare profession and related industries in the sequester's first year alone.1 By 2021, the estimate could be as high as 766,000.4


Budget cuts to Medicare will decrease provider payments by 2% and are estimated at $11 billion in this fiscal year. These cuts started on April 1, and the fiscal year ends on September 30; therefore, the initial cuts will happen over a span of 7 months. The average hospital could potentially expect cuts from $0.8 million to $1.3 million.1 Over the next 10 years, a total of $40 million in reductions could potentially occur if there are no other adjustments to the sequestration.5 In addition, funds that were directed to support the states in establishing insurance exchanges will be cut by $66 million.5 "Research grants funded by the National Institutes of Health will be diminished, and in some cases, eliminated."1


Sequestration is complex and not easily understood. As sequestration evolves, other effects of the plan will become more apparent. Healthcare transformation will be constant and never ending.


Surgery has always been an area that generates revenue. The need to "do things differently" will be a mantra for healthcare organizations. Surgeons will need to collaborate more with purchasing in decisions ranging from bringing in new technology to keeping a specific brand of surgical gloves. Perioperative nurses will be progressively taking on the role of gatekeepers to accurately deliver supplies to the sterile field and identify ways of further decreasing costs while still promoting optimum patient outcomes.


Now we'd like to hear from you. Share the initiatives your organization is implementing with our readers to promote the best patient outcomes while decreasing costs. This can be easily accomplished if you have downloaded OR Nurse 2013 to your iPad. Just click on the Talk Back! icon at the end of each article to share your thoughts. Remember, the journal app is free!


Elizabeth M. Thompson, MSN, RN, CNOR

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Editor-in-Chief Nursing Education Specialist Mayo Clinic, Rochester, Minn. ORNURSE@WOLTERSKLUWER.COM




1. Sequester means looming revenue cuts for providers. news. 2013. [Context Link]


2. Steiger N.Sequestration cuts hurt efforts to improve collaborative health care. The Bellingham Herald. 2013. [Context Link]


3. Ollove M.Sequestration to drain money from health care. 2013. [Context Link]


4. CMS now says sequester medicare pay cut to kick in April 1. Medscape. 2013. [Context Link]


5. The sequester effect: getting ready for cuts to come. The Advisory Board Company. 2013. [Context Link]